Reopening of Peripheral and Central Arteries and Veins

Abstract

Complete occlusion of the central or peripheral vessels are relatively common occurrences in patients with congenital heart disease and typically occur as a result of thrombosis but can also be due to surgical manipulation, inflammation, infection, or ductal constriction. Completely occluded vessels can often be recanalized successfully in the catheterization laboratory; however, these complex procedures require a methodical approach, including judicious use of preprocedural imaging techniques to understand the anatomic extent of the occlusion, followed by careful selection of the optimal vascular access site and gradual and painstaking wire recanalization, followed by thrombectomy when necessary, and culminating in appropriate use of balloon angioplasty and stenting techniques. In this chapter, we review each of these techniques and lay out a step-by-step approach for successful recanalization of occluded vessels, including a discussion of postprocedural management.